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002-1012-60-100
/* yv's°°"git' pel'a~me"tot Comme`ce PRIVATE SEWAGE SYSTEM safety and Busliings Dirnsxxi INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Pe~~rrtrta--ot~tiaylgiMortrlatkxt you provice may he used for secondary purposes [Pfiracy l.aw, x.15.04 (1 xm)j. OCK, MIKe `s Name: ^ City p Village Town o Baldwin ownship CST BM/Elev.: I ins . u~' Ul) ~(/v TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,~ ~ .` ~ovo!>ad /~a~ Oosing ~ ,5 O A Ho ding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. vent to ROAD Air Intake Septic > ~ 7 ~ ~ ~ ~ ~ NA Dosing > >~ D ~ >/ i 7 ~ ~ NA Aer tion Holdi NA PUMP /SIPHON INFORMATION f Manufacturer Demand Model Number ~ ~ ~L 2~• `/ GPM TDH Lift ~~'~ Friction S tem y TDH/ ~ Ft Forcemain Length ~" ~ Dia. Z c ~ Oist. To well 7~ ~G SOIL ABSORPTION SYSTEM BED /TRENCH width , , teng tai ,.._ / No.Of Trescfies ELEVATION DATA ounty: St. Croix Sa 38209 it No.: State Plan 10 No.: Parcel Tax No.: 002-1012-60-100 STATION BS t ~~ ~ ~~~ ELEV. Benchmark 'j . ( JOb 1 O~ . It. BM- ~'3•~ LID. l Bldg. Sewer (~ i SJQ Ht Inlet , y ~/ Ht Outlet l(J~- ~ Dt Inlet l Dt Bottom , q ~, ~ / _ L ~Z . Header/Man. bpd . Oist. Pipe "~ ~Ob- - Bot. System nal Grade D over U g.~ j g'8~~o I DrT NO.Of Pits Inside Oia. Liquid Depth SYSTEM TO P / L BLDG WELL LAKE /STREAM ~ SETBACK CHAMBE INFORMATION Type 2 ~ _ rs )I Z ~r y~s-~r OR UNIT Svstem: lNlw-, ..r. DISTRIBUTION SYSTEM I 3 / x Hole Size' 1 x Hole Spac% g Vent To Air Intake deader / Mani of Distribution Pipe(sjJ J Length ~ Dia. 2 C Length ~/~ Dia. I~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Topsoil ^ Yes ^ No ^ Yes ^ No tied /Trench Center bed /Trench Edges ection #1: ~ /za /mot Inspection #2: ~'" / ~L~Q/ / COMMENTS: (Include code discrepancies, persons present, 45 Location: 1170 220th Street, Baldwin, WI 54002 (SE 1/4 NE 1/4 6 T29N R16W) - 062916846 -Lot 2 1.) Alt BM Description = I~io-l-bw- V 5~~~ :a>^ ~owsQ~ 2.) Bldg sewer length = 3 y~ V -amount of cover = ~~f a " 3.) contour = $.y~ _ ? 1j'. L s Plan revision required? ^ Yes ($ No Use other side for additional inform wn. 2 7 Dat tnspectoi s Sign ture Cert No SBO-6710 (R.3/97j Sanitary Permit Application Safety & Buildings Division ~' In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave, PO Box 7302 ~~ , ~ ,~, See reverse side for instructions for completing this application Madison, WI 53707-7302 ~ ~~~~ ~ Oepf3rtment of £ammerce Personal information you provide may be used fo~nda u oses ( rXp_~~ )(tfi)a'; ~~ ? . s. l 5.04(l [Privacy Law (Submit completed form to county if not ~ y , r _ e state owned. Attach com l ete Tans to the coun co onl f th , on a er not less; a3t -1/2 x 1 l inches in size. ~Wh, 1 State S Permit Number 'f 'sion to oµ~ppli ~, • ~.U s~' Goo, .~. Late Plan I. D. Number ~38'ZO . `• I. A lication Information -Please Print all In ormation ~ cation: n Property Owner Name ~ ,+ ~ ~u ,~ . '- t d petty Loca~ti7on I6 Z~ ~ O ~ `-, ~ ~ AQIX ~ ,N, R ~ or W ~ L/4, S T 1/4 -"' ` ~~! Property Owner's Mailing Address ,*' :. t Number Block NumQber T~ City, State Zip Code Phon tin)he(`~°• ,.,,_ ~ ~ Subdivision Name CSM Num ~ f G ,y cJ~ . syao~ ,, . ~r` ~~~d 6~~3z~ D . ~~ 3~~y . L~, Il.~ype of Buil ng: (check one) ~~ v 1 or 2 Family Dwelling - No. of Bedrooms : V ~ ~ C'ty ^ } jllage (~ of / / ' ' ~ G -T~ t~ 2 ~ y' ^ Public/Commercial (describe use):_ ~ a ~, r~ n o~ ra ^ State-Owned _ Nearest Road ~ ~7~ ~7k". ~(' ~~ ~ 1 O O ~ Parcel Tax Number(s) ~ Z - ~C~Z ~./DA III. T e of P rmit: Check onl one box on line A. Check box on line B if a licable 5 ^ Addition to 6 . A) 1, ew 2. ^ Replacement 3. ^ Replacement of 4. . Existin S stem S stem S stem Tank OnI Permit Number Date Issued B) ^ A Sanita Permit was reviousl issued 1V. Type of POWT System: (Check all that apply) --// ^ Sand Filter ^ Constructed Wetland ^ Non-pressurized In-ground ll~vlound ^ Pressurized Irt-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- de ^ Aerobic Treatme t Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatm 1. Design Flow (gpd) ent Area Information: ~ ' 2. Dispersal Area 3. Dispersal Area 4. oil Application 5. Percolation Rate Required Proposed Rate (GalsJday/sq. ft.) (MinJinch) 6. System Elevation ' 7. Final Grade Elevation ~~ ' x ~ ~ ~,~ ' q9 - d 7 ' o~ i {50 ~ y~ D VII. Tank Capacity in Total # of Manufacturer Prefab Con- Site Steel Fiber- Con- glass Plastic Information Gallons Gallons Tanks New Existing Crete structed Tanks Tanks 1 S ov.Y~~ O~ ^ ^ ^ ^ fie. ~>'' c- boo ~~ ac, 500 1 e ~ Q~~ ^ ^ ^ ^ ~~ C.. Aso -- 7.5c~ ~ j' VFII. Responsibility Statement I, the undetsi ed, assume res onsibili for installation of the POWTS shown on the attached Tans. Business Phone Number Plumbers Name (print) Plumber's Signature (no stamps): MP/MPRS No. ~ ~ Z Z o 8 5 3 ~ ~ _~~ 7/~ - 6Sc~ ro ~, a2,, ale E, } u v Plumber's Address (Street, City, State, Zip Code) ~ ~) IX. County/Department Use Only ~~ ^ Disapproved Sanitary Permit Fee (Includes G undwater Date Issued F " J- S Issu' gent Signature (No stamps) ~ ee) ~~ ~ urcharge I b Ir3'Approved ^ Owner Given Initial Adverse J ~~ / Determination /~ X'.~C~ i4~~ 9f`~~,ProvaJ /Rea~~or Dfis p rova : ~s ~S, s~Q;~.~/ f~ ~6U ~ C~~~,~;~`~~~'I G~-•t~ -fry ' 71 T7 f ~ 1 , Z - O (J.ti,i S t ~ " / ~ h ~ rl.~ ~~Jt~~ ~ n ~ ~ ~ ~ 1 it - ~~•.rnf!("~ '~/t q~ YN~~K'f7ff'1 [l'~C ~TI~L l~~/~' G t t ~~"~~ .fir tN`~rA,~/I{MR~~ 7~~ l~4 yr `,' 1, U ~ jT~`' ._ isconsin Department of Commerce May 24, 2001 CUST ID No.220853 DALE E HUDSON 820 MAIN ST BALDWIN WI 54002 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/23/2003 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Mike Mock St. Croix County, Town of Baldwin - 220a' Street SE1/4, NE 1/4, S6, T29N, R16W FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 477656 Identification Numbers Transaction ID No. 638204 Site ID No. 175759 Please refer to both identification numbers, above„ in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. ~ 4 DALE E HUDSON Page 2 5/23/01 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~~~~~~il GK~'u Gerard M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to :30PM j swim@commerce. state. wi.us ,.`~ ~--~~ ~~T;- t~~~~, r, ~ .._ FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 BALANCE DUE $ 0.00 WiSMART code:`7633 .. ~• a ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary May 24, 2001 CUST ID No.220853 DALE E HUDSON 820 MAIN ST BALDWIN WI 54002 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/23/2003 ATTN.• POWTS Inspector ZONING OFFICE ST CROD~ COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Mike Mock St. Croix County, Town of Baldwin - 220`s Street SE1/4, NE 1/4, S6, T29N, R16W FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 477656 Identification Numbers Transaction ID No. 638204 Site ID No. 175759 Please refer to both identification numbers, above, in all corres ondence with the a enc' The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Pernut must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. . • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. DALE E HUDSON Page 2 5/23/01 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Gerazd M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to :30PM j swim commerce. state.wi.us FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 BALANCE DUE $ 0.00 WiSMAR`f code: 7633 MOUND SYSTEM DESIGN S~ Residential Application F INDEX AND TITLE SHEET Project Mike Mock 3 bedroom residential mound Owner Mike Mock Address 840 Maple Street Baldwin, WI 54002 Site Address: 1170 220th Street Legal Description SE1/4NE1/4, Sec. 6, T.29N., R.16W. Township Bladwin County St. Croix Subdivision Name CSM VI. 14, Pg. 3794 Lot No. 2 Parcel ID Number 002-1012-60-100, ID# 6.29.16.848 Plan Transaction Number Index and title sheet Mound calculations Mound drawings Pres. dist. talcs. and laterals TDH and pump tank drawing Pump specifications Site plan Turn-up detail POWTS management plan Attachment: Soil evaluation report Designer Dale Hudson License Number Signature~~n,Q~ ~;-~ , ,~,.a~../ Date April 9, 2001 ~~~/ i '~- qPR twc 1,z ~ ?~Q ~~j 1 `°~s o,~ • 220853 Phone No. 715-684-3378 P.Q wonaliy Cond ~,~V~~ ~~ ~ ' s OF COMMERCE ~ OEPpRTIJlfttl uplN~. V-g-ON P EPIGE S~ GORE Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 1 of 10 MOUND SYSTEM DESIGN Complete red boxes as necessary. 750 gpd ma~amum design flow. Residential or commercial? ~(r or c) Slope 11 Design flow rate 450 gpd Depth to limiting factor 22 in In situ soil infiltration rate 0.5 gpd/ft` Contour line elevation 98.5 ft Use standard fill depths? OR Design depth? 14 in Place X in box to use standard d epths (24 and A+4 inclusive) OR specify design fill depth. Orifice density 8.65 OrrFces per ft` Center or end manifold (o or e) Orifice diameter 0.125 in o.t2s, o.t56, o.tsa, 0.219, 0.25, Lateral spacing 3.00 ~ ft Use 0 lateral spacing for trenches. o.28t, or 0.313 inch only. Estimated orifice space 2.90 ft Not a final calculation. Number of laterals Pump tank elevation 92 ft Outside bottom of tank. Forcemain length 55.0 ~ ft Forcemain diameter 2.0 in 1.s, 2, 3 or 4 inch onty. 2.067 in Actual I.D. SYSTEM SOLUTIONS Design flow rate Absorption cell Application rate & area 1.0 91~ Linear loading rate (LLR) Design width (A) Cell length (B) Depth of cell (F) Sand filter Upslope fill depth (D) Downslope fill depth (E) Basal area required (gpdrnfiltration rate) Supporting components Topsoil depth Subsoil depth at center Subsoil depth at cell wall End slope toe length (l~ Up slope toe length (J) Down slope toe length (I) Total mound length (L) Total mound width (W) DIAMETER CONVERSiGP~t 1 /8 = 0.125 1 /4 = 0.250 5/32 = 0.156 9/32 = 0.281 450 gpd 3/1 s = 0.168 5/16 = 0.313 7/32 = 0.219 450.0 ft 6.00 gpd/it 6.00 ft 75.0 ft 9.5 in 14.0 in 21.9 in 900.0 ft2 3.0 in 9.0 in 3.0 in ~. 9.86 ft 6.10 ft 15.10 ft 94.72 ft 27.20 ft Project: Mike Mock 3 bedroom residential mound Transaction Number: Page 2 of 10 MOUND PLAN VIEW observation pipes (typicaq T 1 /6 B ~ ~F-->~ A = 6.00 ft 27.2 ft ...•.•.•.•.•....•.•.•.---•.•.•.•.•.•.•.,.•.•.. •.•::: ~ B = 75.0 ft ~ '• J = 6.10 ft W T :•:•: .•.•.•.•B:•:•:•: I = 15.10 ft I K K= 9.86 ft~/ ~, 1/6B = 12.50 ft ~ _ 94.72 ft I =down slope dimension =absorption cell (A~) J = up slope dimension ~ =plowed area 0_x1111) K =end slope dimension MOUND CROSS SECTION lateral topsoil G subsoil cap invert 100.17 ft_____ ___ elev. ------ : :::::::::::::::::::: ~F T ASTM C33 ~ Sand Fill E sys. 99.67 ft y `~ elev. 98.50 ft contour 11 lope typ. obs. pipe (anchored securely) s° D = 14.0 in E = 21.9 in F = 9.5 in G = 6.0 in H = 12.0 in D = upslope fill depth plowed layer E = downSlOpe fill depth Note: Absorption cell media will consist F =absorption cell depth of aggregate and pipe with laterals G =subsoil + topsoil depth at cell wall centered across Ax8 media. The cell H =subsoil + topsoil depth at Cell center media is covered with geotextile fabric. er notes: aystem lnstallatlon to comply wrtn stanaards as specrtleci In IVl0uno t.;omponent Manual version 2.0, SBD-10691-P (N.01/01) and Pressure Distribution Component Manual version 2.0, SBD-10706-P (N.01/01). Note: Soil tester has indicated that an additional 2" of sand fill should be placed beneath dispersa cell. _ Design program will not allow increased depth of fill. Depth of suitable soils on calculation sheet manipulated to allow greater depth of sand fill beneath dispersal cell. Project: Mike Mock 3 bedroom residential mound Transaction Number: Page 3 of 10 PRESSURE DISTRIBUTION CALCULATIONS Dispersal cell Width (A) 6 ft Length (B) 75.0 ft Lateral specifications Number laterals 4 Orifice/lateral 13 holes Lateral length (P) 36.46 ft Orifice diameter 0.125 in Lat. dis. rate 5.36 gpm Sys. dis. rate 21.44 gpm Or~ce spacing (X) 35 in Lateral diameter Pipe diameter Design options Design choice Designer must '~C" one choice from the options provided. Manifold diameter crab "X" one choice from the options provided. 1 in X 1 1/4 in X 1 1/2 in X X 2 in X 3 in x Pice diameter Design options Design choice 1 in x 1 1/4 in x 1 1/2 in x 2 in x x 3 in x 4 in x Place X in red box of chosen diameter. Place X in red box of chosen diameter Distribution system contains: 4 Lateral(s) LATERAL DIAGRAM -CENTER CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Force mai n connection via tee or cross to manifold at any point. P Laterals are identic al ~ =Turn-up v.~ball valve or I4- X-~ IFK/2' Kr2~l Laterals & force main of PVC Sch 40 clea n out pl u g per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. "I' S Lateral length (P) Lateral spacing (S) Or~ce spacing (X) Manifold length Orifice diameter Lateral diameter Forcemain diameter 36.46 ft 3.00 ft 35 in 3.00 ft 0.125 in 1.50 in 2.00 in Project: Mike Mock 3 bedroom residential mound Transaction Number: Page 4 of 10 tiULll i 5 rLti~ ~. rt i v r ax = r 1J-btsu-J1U4 riay 1 r ul 1 ~ • u~ r~~ tDH and Pump Tank Drawing Tool pyttsmla Head Opsratior~ head 8.'30 R Verat;tld lift Q.87 ft M wbrak th. hlphefjt point in tlrs Frtctfon logs 0 ft Y~ "~ hers x-^ Total dynamic head 1 n no: w1r1t ~ d-s L_..-^J pare Volume d0N"'~'M" at w~ taatls is > tlmaf lateral v Foroe~.~+ ~^ Lateral void volume . ,Gt get ~V .X~.,rc' .~ ~'%~ t>Adr ~ arrdCt tx a+e) Minimum doss a gN - l3. v~6 ~ ti~~~ad ~- . x Yss Dram bads 9a t!/9.Y/~~~"~=G7.a9~ No ooze volume ~ r a!~ 9~O' ~~. ~9y'a '1"ypiaal Pump Chamba~ Larcwt In oombinsaion vdth she approved treatnter-t tank appraed merd~ols Dower with ~. wed P~ ~ f'1 . ~~ weminp I~ba! errd toddng dsutos g~ y,ny ~ )tttxaon bmc 4r Vefrt ~ ~ eAiatne M t~- NEC 30D arld C.arrKn 4e.28 WAC waA oT pump Chart~ber or oombaiaQon tenK A eferrrl Or1 pump on 8 Pump 83.3 R C OfT elev. D Tanis mertufacturer ~P qty Pump tarrNc volume • dosddana undertwic Pt,ImP manufadtu~sr Pomp modsd number Alarm manufacturer Alarm madsi number aNen+ri~ outlet k+a~lon 1a' n+ln- Lam- ~~ ~ outlkt Jabd Prdvido 1Mr weep hde or artt~ slrhorr dsvlos as rreoeeet+ry i~ratM twNs poop tar* mmnols ~ 4" mkirrtum eDOw 1M~tehed grads vent ~ 1Z n+pNmum ebcleaitrdihed grade Pump birrk efwMiai K aoaan d errs A i c~all«>s ''9 3BS3Z 8 2 40.80 C 8/./,Z D 2rt3.4o Project: Mike Mock 3 bedroom reaidentlal mound Trattsat~lon Nurr~sr: Page 5 of 10 Performance Curves METERS FEET ~ubrnersibl~ Efflu~r~ Pumps GPM m'/h ~' V METEF 35 30 i I 25' O Q w = 20 J F 0 F- 15 10 5 0 S FEET 120 110 100 90 _ 80 70 60 50 40 30 20 10 0 ~GOULDS PUMPS, INC. SEf~EC.4 FALLS I~EW YDcM 13idp MODEL 3885 SIZE 3/a" Solidsl H '~ °~ W vu o~ tw /U 80 90 100 110 120 GPM L , ~ 0 10 ~ 20 3 m'/h CAPACITY ~~, ~ ~`~O X1985 Goulds Pumps, Inc. E echve Juiv ~ c,q. ^ So; /O.f~/tktl:on P,'~ b y T'?c/san • E/t d a ~i~ SCA/C: / = y0' rw.a~i•L••\wl 1r1 f ~/00.7'(ort~+ of dr i ~c ~Y, c~ cc es5, ~Itd: = /,25, fog v b ° ~~ d ~° ~` a ~i ~ Pr o host-cl 3 ,b edroo m ('eSideNCe- w(~a.btl~4-~~ e{.{'luw~t 5/ ,4.s.T~y. 3o3yp,/.C. f~ 1-tre~a~ o~..t let e,~F~lueh't /,'ne ~ioG,z.3' /1 ~ n Well 3a ~o,~~j ~~stif. e P./.e. buy/dlnve ~oy8/ , Seger /o w9/bl. i ,~, P~e(~ostd 7.Sb~tL. P.c. ~-~ ~~ Ede eet ~~ ~,~;~ ~~l ~c ~~, ~i / ~r i % ~ ~f ~~ ~~ a i i ~~ e ~ a i / ~v " ~ r ^ i ~ ~~ 99.9r' ,2~~s~. vo/dc. .Forte Ma C9~ o~ o~~ ' bo cct1~ n ~ i % ~~ ~ ~~ / ~ a~ ~~ , ~ / . / ~ ~ / ~ 98.E ~, / i ~~ / ~~ pr'ep• nc~ ~ ToPc a.~.E. /+ss Kmtd cr. = ibc).ca: (,~ A`Ge~ -~ Access Box Threaded Plug Lateral ~ Manifold ~L Orifices ~ Lateral turn-up detail Pg. 8 of 10 BOLDTS PLBG & HTG Fax 715-684-31411 Ma 24 'Ol 08:38 P02 POWYS ~?WNER'S MANUAL S MAIYAG~MENT PIAN roee °'-~ FILE INFORMATION Uwner ~L./i~ ~ pG~ ~ i ail ~'°' n~~ltZN PAt2AMITPRS Number of 6edroome ~ ~ ~ Q NA Number of Commercial Units Estimated flow (avCrige) ,~ aV DatiBn Avw (peak), (~Hmat®d ~ 1.S) aViia Soil APPtloetian Rate ai/d l!t' IntluentlEffluent quality Monthly r~vecage' Fats, t71i & Gfease {FOO) s30 mgJL @IoGhemitail Oxygen pemAnd (il~~ ~ZO 111Q/L Total 9usponded t3oNds (TSS) sleo m !L Prstre~d EYMaont auallty ~ - CI NA Monthly averaga'* . Eklotlemlcai Oxygen Derrtand (®OD~) S30 mg/l Total 8uepended SoWda ('T88) s30 mall. Fecal Calttorm eortmbic mean s1.0' ctu/100mt Maximum EMluent Par#cle 5<7:e ~ inchdtltrneter M11tNTENANCE 9CNEDUL~ SYSTEM SPECtFiCATlvns ~.w...~. Septic Tank Capacity gal d N!+ _ ~eatrc TanK I~lanufaaursr ~ ~ 'G 1/' _ o Nr. Effluent Filter ManutaC~ ^ NA Effluent t=liter Made! a - Ark D ~ Pump Tank Capacity ~ Q at t] NA Pump Tattle Menuiectu~r ~ ~~$ ^ NA Pump Manutacturor ~ C7 +~ Pump Mode! D.31 . 0 NA Pretreatment Unit, D S»tndlGravet Filter d Mschank;al,tlei'aaon O Dfslnfectlon C] Pent Filter , O Widartd . t7 Oa'!~' . - .. 0lspenzel Ceps) . d In.groand (g~wviht} d At~n~de l7 Drf •dkte . Q ~-ground (preesnrl'zed) ound ~ Other: . . Vawes ty{+IoMt !br don'INee (noMaolllfn~edsp rwlsaMA~' and ~ b~ M~w+1t. r w. VRkla~ !w pNMS~ trtsta~u Service 8vent Ssrvtri Frsgwncy inspod onndition of tank(s) Ax least onos wary 3 O r>lbrea-s • yew(s) {tirlaetmum a yrs.) Pump ~ oohtantg of tank(=) ~ When gombtned sedge end scum squab ~ledfilyd (K} of tank volume Inspea dteperaal oell(a) ~ ~ At.least once wary O months -~ y+ear(a) {MaxttYlstrrt 3 yrs.) Ciaan eifit,ertt filter At feast onoe wary 6 d months D ywiKa) . Inspapt pump, pump cantr+,la 8 alarm At Isast onoe every Q rr>q~ts • yeer(y O !dA FfusM lateraN and pressure mss! uteri! onoe every O mortats~ iyeu{,) CI NA oii-e~ ~ at least once every O mo~to~ D ye~{s) D tiA . . oth.r: ~ At IeMSt once every i~ months !'~ ywr(s) DNA MAINTENANCE INBTRUty'1'IONS inspa~otbris of tanks and disRpersal wits sham tae made by an tridlvidual ~M+19 one of dtb irattoa-Ina Noense~ or aertl3catlons: Master Plumber; Master Plumber Reutrk~sd tower, POWTS lrtapectar; POVVT~ Mainainer'; 9eAtage SetYicing 4perastor. Tank irtspeedona must Include a visual fnsaectton Qf th4 tsnktxl t4 IdentiAr antr•mtsslt~s or txoken hard'~vara, efy any araclis~or leeks. mes~sure the volume of oomtsoted sludge and scum and m check 1br any backup or ptrnding of'eftluent on the ground suifiioe. Thi dltiper>sal call(s) be visually tnspected~to vheok the iffluent'Ievels in tho abearoatlon pipes and m cheek for Imy pondlna of elEuent on qte ground eui°hi~e. the pwte~ng ol= attlusnt ~ the ground aurtaos tray indicate» fagirtg aonditlon and requires the kr-ntediate nodAcafleon of the focal reyirtetoty authority. when tlt~t combined accumulatipn o1 etudg and Iraitm in soy tank equals one~third (~ ar moro ~ the tank wtume, the entire ocntertts of the tank shall tae nnwYed by a ~eptaQe~$ervtdng t]peratvr and disposed of in aoaordw+ee with ch. NR 113;1Nisoonsin AdmintstratMe Code. ~ : • The aenridng of effluent tiltenl; meohanloai dr preesurized'POWTB eompanents, pritroa~ment oomporien~;~~and'iny otter melntlananoe or monltorina rMt Mtanrals o! 72 rr±orttr~s cr,lass shall be pafwmsd,by a ae~ted PO.WTB tutat~tt~il~:~~ "= ", . • ~an service went. A Nnlt~ nspott shall be pravtelad >b the local ragulat~ory aufhorsly within 10 days aT oomptadori Or Y $TAitT UP ~D QPEFtATION ~ ' For rtaw oorwductlon, prior to use of the POWTB check tratdwtent bank(s) for the preeeriea of p8lnting products or ether . chemicals that may Impede the troatment prooesd and/or damage the dlspen><st cstl(s}. If high cortr>mntratbns aril . dete~.~ed have the aortMnts of the tank(s) r+srrtoVed b'Y a aeptape servicing operator prbr to use. BOLDTS PLBG & HTG Fax 715-684-3144 May 24 'Ol 08:38 P04 i Piyv ors. System start up shall nOt occur When aoll oorldittons ore fraren at the intti4 drive tu[tsoe. oaring power outages pump tank3 may Rli above nvRnat ~highwater levels. Wt+en power is restored the excess ' wastewater wilt be disoharQed tv the dispersal cell(s) in one large dose, overloltdMg the oe~(s) and m>!Y result in the btlCkup or surface disc~arpe of sfRuent. To 8vpld this bituatlon have the contsngl Qt the Aw'np tank removed by si Sopt~e Servlctng pperatorprto[ tp restoring power to We effluent pump or called a Plumber or poWTS Metntainer to assist in manually oPeroting the pump cantnala tiD restore normal levels within fhd pump.tank. .. . Do not drive ar perk vehk;Ne over tanks and dkpefsai oeila.• .t?o reef dmre or park over, o[ otherwise disturb. or compact, the ~rpa wehin 16 feet down alape of any mound o[ eUgrsde soN apsorpaort area. .. . - Redudion or eNminetton of the 1bllowMg from, the wastewater stream may imptow th0 peftor'manoe and prolong the life of the P011VT'S: antiblodca; baby,wfpes: etgee'at~~butb: condoms; ootben'swabs: de9roalt94tit dental Ross; dtopefx: dlsinfeotents; fat: fotittidatlon drskt (aump. ptfmp~ water ttvft end vegebtbte peelings; Estee; gt+ea~:. herbtddet;• meat sr~: rrredicalioM; oh; painting Products; peskafdes; sanitary ru~kins; tempdrte: and water softener brine. ABANDONMMENT : ~ ~ ... ~ . VYhen the P0lllrry6 tabs andlo[ Is petmarlecitl~l taken, out at setvioe the ' : ~ be taken tQ ogre tttet the eyetecn la property aAd satttey abandoned: in compliartae with cll. Comm 83.35, , ~ Administrative Code: Ali piping b tanlu and~•pib sttaQ b~ dtscori_nected end the abandoned ~plp~ opert~gs d•` ~' ` ~ . -:. • The contsrtts o< a~ fanlu and pile ahsll tti snnovdd grid properly dtsposid of by s 8eptags tlteilrloktg gpsrato[. • ARer'pumpinQ, aN butte ilnd t~ ~ahetl be e~acatinebed and removed or thelbr r~smoved and the veld space Riled with eo~,•.Et+avel or ltttother inert sold material. ~ ~ ~' . CONTtNI~t~<tilf trt,AN - . . if the PU11VT8 fidhc and oanttctt bs ropakrd the following measures have been,or' mud ba taken, to Wgvlde a node Punt rophoemen yate ~ O A wltnble n tpGus~et~lt atro>II halt; begirt eviltusted and maybe utilbced fcr file looadon of a mp(eoemertt soil ataorpgort system. The espitroar'ttsrtt Brae shotsd be protested from dMfl~attoa and compao0ott and shvutd trot be Mtlingad upon by roQulrod setbaeatcs fl+om udsting grla propoaeq sbticbaga, tOt pnaa and vMede: ~Pstluro to . ~ pn~Eect the nplaoement arai wE rosult kt the need for a new soil ar-d a~ iualtralbn to estatdstt a suitable replaoernent area. Roplioemettt eystsmv must comply veldt the ruNs In alhd rt tltd tkne. O A auttatse nplacerttutt area b nvt available dw ro setback eirw-or eoN xrr~ons- Barring advartoes in POWf8 by a hotdlns taatc ttta,- be MateUed as a last resort to ceplaoa'<tle t<tMed POtfYTS. , .Q Th4 eke h~~not b~ libel to idatitlty a suitable [epbioerttent, it~+eq. Upon 1bMutri of the POMVT6 ax ~ebll and , site evaluetlon mutK: ~~~~ to locate .a suitable trrpteoertrent at~l. !! +~ !K ar+n i>S avallabte a holdlrtE ta[tk rttay bo' as a tad resort to roplaoe the fined Pi~V~T'8. ~ . d Mound and.st-gradi aolt~~bsorptla+ maY be reonh~ td Piaoa ~o~p rattove~l of the btomat at the Mfltlntive auehroe. Raaonstrtletlons of each syRtema must comply veldt the fates in et<bot at tlidt tittle. «WARNINtira ' •' ~ ' Sf"pl'IC, PUMP ANA OTf{ER TRIATMEMI' TANKS AAAY ~bNTA1N LETHAL ANDI~OR tNSURlr1Cl~NT ~XYOEN. DO NOt ENTER A t3HhT~,'tIMP OR OTHER TREATMENT TANK UNdlR'AtilY CIRCUAABTANCEE-~ DEAY'M MAY RE9ULT. RESCUE dF A PEON ltROM THE tNTER10R OF A TANK MAY tl~ DIJrlrICULT OR jM,POa6<BLE.. •. ADDITIUNAI. t,",OMMEIVTS . • ~ ~ :~ . ' ~ -~-: •.•, `• • - . bAU1R'~ 1NlT~1 1 MQ Name ~ 1" Phone ~ ~ ~ w~y- ,.~'3 . si'PTAGP i~tVlCiNO QPtsRATyils~ PUMP ~ L 1 Acrl'M~1td'1'Y ~j ~~ anon. ~ z -~ oZ ~ ~~ ~ ~_ ~~ 6~fl .. 'red, dvatirniM wa enlba -y tMN,,etMist3r••n talal, M~quMtr.nd w.wrm. oeunb-.~k+D aw =--~apri4dMs. ,'l~l doarp~nt . . t-i. ~InM+nan rgwlromer+f! of di. Q+'enw-:~i)tt><e~m .red ss.~ti ), !~ a (3}, ~wrsaa+~in ~ldrn4deeaiibe~. uii'oritib QooumMt depi'r~t . , .:., wl.tvewh~i ~fu w~.Iw.r~.~ .I ~L. A/M~/'P~ ~ .~iw~~•~ii•` - Wisoc^~'~ Department of Commerce SOIL AND SITE EVALUATION Division of Safety'and Buildings in accord with Comm 83.05, Ws. Adm. Code Page 1 of 3 Etrvironmental By Desimi Attach complete site plan on paper not less than 8'r4 x 11 kkhes in size. Plan must County include, but not limfted to: vertical and horizontal reference point (BM), drrecdon and $t. Croix percent slope, scale or drmemsions, north arrow, and IocaGon and distance to nearest road. parcel I.D.# APPLICANT INFORMATION - Please rint all Inforn-ation p . Personal inforrrmtion you provkle may be used for secondary Purposes (Privacy l.aw, s. 15.04 (1) (m)). Reviewed B Date Y Properiy Owner Property Location Moc Mike Govt. Lot SE t/4 NE 1/4 S 6 T 29 N,R l6 W Property Owner's Making Address Lot # Block # Subd. Name or CSM# POB_373 2 Mock City State Zip Code Phor>BNumber ~ City ~] Vtlage ®Town Nearest Road Baldwin WI 54002 684-3741 Baldwin 220Th St New Construction ®Residential / Number of bedrooms 3 ^Addition to existing building Use: Replacement ~ Public or commercial describe Code berived daily flow 450 gpd Recommended design loading rate 1.2 bed, gpolft2 l .2 trench, gpd/ft2 Absorption area required 375 bed, ftZ 375 trench, ftZ Maximum design loading rate 1.2 bed, gpd/ftZ l .2 trench, gpd/ftZ Recommended infiltration surface elevation(s) y9.2g ft (as referred to site plan benchmar Additional design /site considerations Parent material loess over till Flood lain elevation, if a plicable Na ft S=Suitable for System Conventional Mound In-Ground Pressure AT-Grade System in Fill i Holding Tank U=Unsuitable for system ^ S ®U ®S ^ U ^ S ®U ^ S ®U ^ S (~ U ^ S ~ u SUIL DESGRIPTIUN REPUKI Boring# l Ground elev __94.45 ft Depth to limiting factor 25 2 Ground elev 94.50 ft Depth to limiting factor 24 Horizon Depth ~ Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPDIft~ in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ;Trench 1 0-8 10yr4/2 - sil 2msbk mfr cw 2f .5 .6 2 8-12 10yr4/3 - sil 2msbk mfr cw ~ if .5 .6 3 12-25 7.Syr4/6 - sl 2msbk mfr cw ~ ~~ - ~ ~ __ S 6 4 25-42 7.Syr7/2 c2d54/6 scl lmsbk mfi i cw - 2 3 Remarks: 1 0-9 10yr4/2 - sil 2msbk mfr cw 2f .5 ~ .6 2 9-16 10yr4/3 - sil 2msbk mfr cwr ]f .5 .6 3 16-24 7.Syr4/6 - sl 2msbk mfr cw - .5 .6 4 24-40 7.Syr7/2 c2d54/6 scl lmsbk mfi cw - .2 .3 Remarks: CST Name (Please Print) Sgnature: Telephone No. Thomas C. Nelson 715-246-2454 A~ro~ Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 6/16/99 227387 242 PR~JPi7?TY OWNER: Nrook, M;ke SOIL DESCRIPTION REPORT ~~12 p~ 2 Of 3 RARLEL I:D11r ~ Pavinoc~meotal By Dai¢n ~3 ~Y~~~ ~ ?w!,7y.~~P: Ground elev 97.78 ft Depth to rn-,ang factor >44 Horimn ~ Dominant Color Mottles Texture Structure nstsbe Boundary Roots GPDlft~ i Munseq Qu. Sz Corrt. Color ~. Sz Sh. Beta : Tr>rnch 1 0-9 lAyr4/2 - sil 2msbk mfr cw Zf .S ~ .6 2 9-25 10yr4/3 - sil 2msbk mfr cw ]f .5 .6 3 25-44 Syr4/6 - sl 2msbk mfr cw - .5 .6 Kemancs: Ground 1 eiev Depth to I'rmding factor Remarks: ~:-. ,_~~s ~. Ground eiev Depth to limiting factor Remarks: a ... ~: R.=NR. ~~r Ground elev Depth to limiting factor r~ernarRS. ~, ~ ~.~ 1432~~~~' S' ~1~CFIIVIOND W~SC(~ SIlJ . 4 ~.. - tsn .t.3 La ``AA .. Tam Nelson Certified Soil Tcster 227387--Rcgiatered Sanitarian SR00713 #################4#########*#######################;############t B>' M. ~ k ~ CYl o c.k S{~4. %y ~ ~ ~ ~y 1 S e c 1. c. ~ ~. W ~ n ~ o c,.l ~'1 S }~ IV -- - -------~ ``s e 1 1 ~- a g z q, Si ,~ ~~ ~~ ~~ ~, g0 S~ l Q~ q~~,~s g~ gy, 50 ~3 ~~. 78 SCALE 1" = q p ~ ~1`'~1.ToP u~ nc.i~ ~n ~os'~' ~lev 1v0~ aM2 -r~P ~~' ~w1~~.R.t ~y,38, Tom Nelson -~- U ~~,5z 10 0~ 10 c~1 7 1 0~ Wisconsin Department of Commerce SOIL AND SITE EV , ON- , Divisron of Safety and Buildings in accord with Comm 83. ,~V1(is .Adm. Code 4 Page 1 of 3 Environmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan r °~`~- County. include, but not limited to: verfical and horizontal reference point (BM), directio pi1$~ t t '"• ~ :'~ ' ~ , St. Croix percent slope, scale or dimemsions, north arrow, and location and distance t nearest road. '' ~- ~- paroet 1. ,# r. APPLICANT INFORMATION - Pl i t f ll i t ease pr n orma a n ion. ~} : Personal information You provide may Ue used for secondary Purposes (Prniacy Law s ~5.b4 (1) (m)). ti; R viewed By Date ~ 2 ~ 1 Property Owner property ~~#+ '~ Moc Mike Gdyt. Lot ~ " ~~ 1/4 N~ 1!4 S 6 T 29 N,R 16 W Property Owner's Mailing Address Lot #~~ Block # Subd: Name or CSM# POB 373 2 '"~~ __. ; Mock Ciiy State Zip Code PhoneNumber ~ City ^ Village ®Town Nearest Road Baldwin WI 54002 684-3741 Baldwin ~ 220Th St ~ Residential I Number of bedrooms 3 ^Addition to existing building New Construction Use: Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 1.2 bed, gpd/ft2 1.2 trench, gpditts Absorption area required 375 bed, ftz 375 trench, ~ Maximum design ksading rah 1.2 bed, gpd/ftz 1.2 trench, gpd/f1? Recommended infiltration surface elevation(s) 99.28 ft (as referred to site plan benchmar Additional design /site considerations Parent material loess over till Flood lain elevation, if a licable Na ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ s ®U ®S ^ u ^ S ®U ^ S ®U ^ S ®u ^ S ® U Boring# 1 Ground elev 94.45 ft Depth to limiting factor 25G 2 SOIL DESCRIPTION REPORT ol.~ (` ,.~.~ , 2,utsD ~ ~ ~1 H i Depth Dominant Color Mottles T t Structure Consistent Bounda Roots GPD/ft2 zon or in. Munsell Qu. Sz. Cont Color ex ure Gr. Sz. Sh. ry Bed ~, Trench 1 0-8 10yr4/2 - sil 2msbk mfr cw 2f .5 .6 2 8-12 10yr4/3 - sil 2msbk mfr cvv if .5 .6 3 12-25 7.Syr4/6 - sl 2msbk mfr cw - .5 ! .6 4 25-42 7.Syr7/2 c2d54/6 scl lmsbk mfi cw - .2 .3 Remarks: 1 0-9 10yr4/2 - sil 2msbk mfr cw 2f .5 .6 2 9-16 10yr4/3 - sil 2msbk mfr cw if .5 i .6 3 16-24 7.Syr4/6 - sl 2msbk mfr cw - .5 .6 4 24-40 7. Syr?/2 c2d54/6 scl l msbk mfi cw - .2 ; .3 Ground elev 94.50 ft Depth to limiting factor ~~ Remarks: SST Name (Please Print) Signature; Telephone No. Thomas C. Nelson 715-246-2454 address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 6/16199 227387 242 ~S~ • S' ,S .~ . ~" • .S' y ~' ~ ~~~~ i~ L ~ 1432 120` S TREET, NEW RICHMOND, WISCONSIN 715-?A6-2454 Tom Nelson Ceri~fied Soil Tester 227387---Registered Saanitarian SR00713 ~~M+k~M1~L°:4*~k#+v;~#*~k+k~k~k+klH~+k~#!+R###i#####t#+i~tMM1~+1•~k4+F~k~k#*fMi~i~tt~kit~k#M~#~k# B~' S4_~y~ ~~ ~y ~ Sec 'V/ i ~ - ---_., -- ___.__~ ws e__ ~ I ~ , i ~, ~~ ~~ ~1~ ~~ 90 ~t Qi q~1-~IS B~ gy.50 ~3 ~~. ~ g SCALE 1" _ ~ O ~ ~B~1_-1'op u~ f1Gt ~ lr1 ~ oS~ ~.1pU 1 U O r Tom Nelson K , l 7 ~~ on -f- V7 ,.c -,~-~ G`~ ~,v Q~,S~, 10 0~ 10 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - OWNERSHIP CERTIFICATION FORM Owner/Buyer jP~~° j`~/f('~ Mailing Address _ ~ ~ ' ~ a ~! x'73 Property Address ~~~~~ .~ ~ ,moo za©~ ~s~. (Vcrifrcatioa required from Planning Department for new City/State ~A~G~id ~' ~.. ~,~~ , Parcel Identification Number ooZ - /A/Z - ~d ~ Lfl~ ~,EGAL DESCRIPTION Property Locafion -~~ %, /~/~ %,, Sec. ~~ T ,29N-R ~~ W, Town of ~4~G~W/Y/ Subdivision N~ Lot # °~-- t~ Certified Sarvey Map # ~/ 73 ~ ~ Volume ~ P e # 3 ~ 7 warranty Deed # ~~~~jr3 Volume ~ ~ Page # -1~-.. Spec house ^ yes l~ no Lot lines identifiable Q'yes ^ no SYSTEM -MAINTENANCE Imgropcr use and maintcnaaaof your septic system eoald t+esult is its pnemamiiefa~ure to handle wastes. Propcx maiateaan~oc consists of pamping oat the septic tank evay ~+a Y'~ ~ if needod by a licensed pumper, What yon pat into the system eaa affect the fa~mctioa of the septic taalcu. a h+eabmeat stage is the vrasto-dispOSal;systeni, . TTbe pmpaiy~ owner agrxs to submit to St: (k~oix Zaniag Departm~art a .ratification form, signed by the owner and i~r a ~~Pl~y~aplambcr, reshidedplr~beror a Iioeasodpamperverifying that (l) the oa~ito wastewat.erdisposal system is in proper operating condition and/or (2) after inspoctioa and pamping.(if accessary), the septic-tank is Less .than 1!3 #aIl of sludge. . ~, ~ mod have read the above rogaincmeats and ague to maintain the private sewage disposal system with the standards set forth, lux+cin,'as set by the Departme~ of Commerce and the Department of Natural R,csoun„es; State of Wisconsin.. Certification stating that Yom' septic system has been maintained mast be completed and rchrmal to the St. C~oix.Cormxy Zoning Oi~oe within 30 daysof the e ~ year expiration date. SIGNATURE Olt APPLICANT / / DATE OWNER- CEItTII'ICATION I (we) certify that all statements on this form are true to the best of my (our) laiowledge. I (we) am (are) the owner(s) of the Property dcscnbod above. by virtue of a warranty decd rooorded is Register of Deeds Office. SIGNATURE O APPLICANT DATE «««««« prey information that is mis-represented may result in the sanitary pemrit being revoked by the Zoning Dcparvnent. «««s«« «• Include ~vlth this application: a stamped warranty decd fmm the Register of Deeds office n copy of the certified survey map if reference is made in the warranty deed ` ve1.15~~PAG~ `~~ STATE BAR OF 1yISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Allen L. Mock and Ann M. Mock, husband and wife Grantor, and Michael J. Mock and Tori M. Mock, husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Southeast Quarter of the Northeast Quarter (SE 1/4 of N~E 1/4) of Section Six (6), Townslup Twenty-nine (29) North, Ran~L~i~~~+~=x'16) West, St. Croix County. Wisconsin described as follow : of Tw of the CertLle ~'1rl"'e}' SL2ap 2?led in ,~ GiiIt'i2 14 vi` Ccit?t!e'~ C~n,p~, ?~~4ry Dn~.P 3794, as Document No. 617321-- ---~. E•36853 KFiTi =N H. WflLaN f::ti=~~':a~TEn GF DEEDS ST'. CF:QIX CQ., WI kECEIUED FOR RECORD 01-16-P001 9:30 AM dIARRANTY DEED EiiEMRT # CERT COE~Y FEE: CORY FEE: TRANSFER FEE: 18.00 RECORDING FEE: 10.00 F~AGES: 1 Recording Area Name and Retum Address WESTconsin Credit Union R60 Cedar Street Baldwin, WI 54002 002-1012-60-100 Parcel Identification Number (PINj This is not homestead property. Exceptions to warranties: Easements and restrictions of record. ~. ~ ) Dated this ~; ~ day of ~~~~ ~.~ ~; _ , 2001 U * s AUTHENTICATION Signature(s) authenticated this day of * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI54002 (Signatures may be authenticated or acknowledged. Both are not necessary.) tai {is notj ~~ z * Alle ~ Mock ,~'~_~~~1 1 ~\ ~ ~ 1~ 1(iC-~tr--~ * Ann NL Mock ACKNOWLEDGMENT STATE OF R'ISCONSL'~T _ ) ~- f/,/ ) ss. y~ , t~t__ r~~-~ County ) Peasonall_y came before me this /ryC.~=j' day of "_ ~a• w . 2001 the above named Allen L " ock and Ann M. Mock to me krlown to be the person(s) who executed the foregoing instnifnetlt and acknow dged the same..;' 1. ~~."~. s Notary Public, State of Wisconsin My Commission is permanent. not, state exprrat~on te. ~~ * Names of persons signing in any capacity must be typed or printed below their signature. i~ro~~tb~ a~or~b~aK co~~y, Fond d~ ~~, wt WARRANTY DEED STATE BAR OF WISCONSIN sao-665202 FORM No. 2 - 1999 . Z~• m `ten ~Y P w t m ~ NE CDRNER CERTIFIED SURVEY MAP I I v~i SECTION 6 LOCATED IN PART OF THE SE1/4 OF THE NE1/4 OF SECTION 6, ~ ~ T29N, R16W, TOWN OF BALDWIN, ST. CRUIX COUNTY, WISCONSIN, UNPLATTED LANDS OWNED BY OTHERS + ~I~ + o NORTH LINE OF THE SE1/4 OF THE NE1/4 ~ `0 N89_'40'09"E 1325,87' - _ _ ~ ~ C Z 5 1.80 ~ 1292.83' 784.07' 51,03 - - - ! 33.04' ,I I(U ~~ 4.6'+/- LOT 1 ra to ;r a+ z a~ ~ ~ _~ u w 0` ~yN F ~ Q ~ a ° q W p fh o WWy I Q~z[Y Q~ l~ W W ~~CQ 0 z Woo pq R ^ a a ~ rnzE t,~~ Z ZJy O to H y a Y U 0.W1W~0 W J W Q _- D + Iv 4.674 ACRES INC. R/W oRlvEwg4__~m ru ~ ~ 0 203,619 SQ. FT. ' I ~ olo ~ ~_ ~~ 0 4.478 ACRES EXC. R/W11~ `~' /1 ~ °• to f/~ I z 195,039 SQ. FT. j ° N89'40'09"E 784.07' ~ X33.04' ~~ jd W i OWNER ALLEN MOCK N44153 JACOBSON ROAD DSSEO, WI 54758 LEGEND ALUMINUM COUNTY SECTION CDRNER MONUMENT FOUND ~ 1' IRON PIPE FOUND CZ o 516.03' 235.00 ~ ~ A ~ r V l ,r i ~D ~ I -I ~~ p I ~~ Id N i i w Z OI .. I~ ~ i ~I ~C ~ I~ ~ 1 Id O) w ~ ~ ro `.~--~5L03' £ LOT ~ FIELD DRIVE ~ ~ N cn 0 4,674 ACRES INC. R/W ~ z o 0 203,619 SQ. FT. ~ --I Q ~ 0 4.478 ACRES EXC. R/W 1 ~ ~' 0 195,039 SQ. FT. ~ ~' '~ 516.03' 751.03' ~ ~ S69'40'09"W 784.07' a y ~ ~ ~ g 41 ~~ LOT 3 = >/N ~ a~ ~ ~ z ~~' ~ 6 25.651 ACRES INC. R/W ~ ,a 1,117,367 SQ. FT. ~ A ~ 25.174 ACRES EXC. R/W 1,096,596 SQ. FT. ~ -- -.o ~ ~ A U ~ J~ Y r i~ l ~~ W ! I/ V ~_ _ y/ i ~ _, 11'+/- ~ 1297.08' ~~ S89'40'09"W 1330,12' ~" v, %f; UNPLATTED LANDS OWNED BY OTHERS -- j~ iD o I ~~ ~~ i ~h _ ~ i~ ! o ' b 33.04'- 0 1 ~ W I ~ O ~ N 1 ~ I ~ N I i ~ V i ~ ~ N,m wl i ~ I I ORIVEWAY__~ ~ -- i i I i i I i 33.04' 1' X 24' IRON PIPE WEIGHING 1,13 LBS. PER LINEAR FOOT SE '"-"' 100' ROADWAY SETBACK LINE r1 I IC ® STEEL SURVEY MARKER FOUND ~ jZ i EXISTING SOIL BORINGS ~ r, ~ ~ '~~ ac-x-x- EXISTING FENCELINE i 1 ~ Z ~~ NOTE: Field drive to be relocated a r~ '-~ to~tion ~ I ST. CROIX COUMY I i~ Planning Zoning and Parks Committee ~ = JaN 2 4 X000 i ~~ w I N It not recorded within 30 da}5 of ~ I approval date approval shall be null and vad ~ SCALE IN FEET 1' = 200' 200 0 X00 400 I I I N 03'0 170.82' E1/4 CORNER Il~?~SECTION 6 rn n M. a; a 0 , ~ fAA3 ~JW QW w ~ G' .N.tiN /~3A • 1' O =cam ~ ~' ~ ~t:S x ac --~ =HV N H Foy!-• y~(y~~ t~6L£ aged fi ~' lon `,, •ao!npn .~o~ p.~nog unnol a}n{,~do,~ddn pun ao{~~p 6u!uoZ ~(}unoG x!o.~~ •~S a~{~. ~.on~.uoo Iao,~nd ~(un 6u!doianap ,~0 6u{so~{o,~nd a.~o~ag •<•o~.a '{ao,~nd o} ssa»n 'az{s ~o~ wnw!u{w 'spuni~aM '•a•{~ suo{}oin6a.~ pun sa{n.~ 'sMO~ d!~{sunnol pun ~C~unoG 'a:~v~S off. ~.oaf'gns s! «.n{d~ dnw s!~,{a. uo unno~{s {ao.~nd ~on3 ~-°~~'~ ~ , *~tZ~-SN •~ s d31H12 y N •r smonoo a,- so~s,M ~0 ~y 9i0~S IM 'uospn{.{ 'a•S ~nu1nM c iZ 6u!~(an,~nS pun-{ N '8 S SbiZ S~~J ual~inZ 'f so{6noQ 'awns 6ulddvw pun 6u!~Can.~ns u! u!Mping ~o unnol a~{~. pun x!o.~G •}S ~o ~C~uno~ a~{} ,~o aounu!p,~p uo{s{n{pgnS punk a~{~. puo sa~n~.v}S u!suoos! M a~~. ,}o b8.9EZ .~a~dnN~ ~o suols{no.~d a~{~. ~~lnn pa!idwoo ~(pn~ ann~{ I ~nq~ rpaq!.~~sap pun pa~(an.~ns ~C.~npunoq .~ol.~a~.xa a~{~. ~o a{nos o~ uo!~.n~uasa.~da.a }oa.~.~oo n s! dnW ~(an.~nS pa {~1~..~aG sl~{~. ~-n~l~• ~C~!~..~ao os{n I •p.~ooa.~ ~o s~.uouanoo pun suol~o{.~~.sa.~ 's~.uawasoa .~a~{~o pn off. .oaf qns pun dow s!N~. uo uMO~{s so «aa.~~$ N~•OZZ> pno21 uMOl a~{~. ~o ~(oM-,~o-~-~i6l~f a~{:} off. ~oa('gnS <'~•.~ 'bS Oi9'~ZS'i> sauot! 000'S8 su!n~.uoo iao.~nd paq{.~osaQ •6u!uu{6aq ,~o ~u{od aN~ o} a.aa~ Lg'SZlrI 'au!~ ~{~.~ou p!ns 6uoi•o '3.60.01~.68N aoua~{~ ~aul~ ~{~..~ou plns o~ ~aa~ Oz'6~ii 'au!i ~.sann p!ns 6uo{n 'M.Ot~,BS.ZON aoua~{~. `~/i3N aN~ ~o ~/i3S plus ~o aul~ }sane a~{~. o} :}aa~ ZI'0~8i N~.60,Ot~.68S aoua~{~ ~~.aa~ 68'6~ii 'au!1 ~soa pins Guo{n '3,ZZ,90.80:i 6u!nui~.uoo aoua~~. !6u{uu{6aq ~o ~u{od aN~. 6u{aq },/I3N a~~ Jo ~/IBS a~{~. ,~o aull N~..~ou a~{~. off. }aa~ S6'6LZi 'b/i3N a~~ ~o auli ~ sna a~{~. 6uo{•a '3.ZZ,90.EOS aoua~{~. c9 uol~.oaS plus ~o .~au.ao~ 3N a~{} ~.n 6ulouawwo~ :snnopo~ so paq!.~osap cu!suoos!M '~(~.uno~ x{o.~~ •~S 'u!Mping ~o uMOl '~.saM 9i a6un~{ '~{a..~oN 6Z d!~sun~o~, '9 uo!~.oaS ,o ~ii3N a"~+ ~o t~/i3S ail=~_~+o ~-.end n paddnw pun pap!n!p 'pa~Can.~ns ann~{ I '~{ooW uall'd ~o uo{}oa.~!p a~~ ~q 1-n~~ ~~!~-ua:l ~(qa.~a~{ ',~o~(an,~nS puo u{suoos!/~ pa,~aa.s!6a~{ '.~al~{nZ •~ sn{6noQ 'I 31dGI~I12i3G S-2iGJl3n~1f1S Y+~^~ 03/27/01 18:29 IJ0.427 P002/002 THE ~~x44 AI G]r.: -C .,oocoao aancaocQ 7ooocaaoooc~ccaa~~=eooccoc ao. ' ~aoaaooaaooaaoooeaaaaoac~o o g/R•.3 a aoco=QC~Qa000OQO eo 0 ooa~i7~ acooaooao co 9'-3' 000 aaao~~coeeoooaoc ^~ 7AC~.C: G~~ ~ alp apc~~oaoe F a~eo a_o a~_ gttao oao DASEMEIVr IICCCSS M-~/R 18 ~. H/R-2 81R-2 13'-4' 10'-5 10'-5 FEATURES 30" CA$ RANGE SHINGLED ROOFlVINYL SIpINC 2 X ~ SIDEWALLS 30,GAL. DELUXE WATER HEATER SCULPTUREp CARPET-iNG. M.BATH CATHEDRAL CEILINGS THRU OUT COTTAGE REAR DOOR DEAD B~?LT LOCKS DEEP STAINLESS STEEL KIT. SINK H2O S.Of=FS-LAV, SINKS & COIIfIMODES OSB SHEATHING THERMOPANE WIN00!WS TILE LOOK BACKSPLA5H FROST FREE REFRIGERATOR R-19 FLOQR INSULATION R-19 WALL INSIJLATIQN R-3U ROOF INSULATION AUTO IGNITION FURNACE DELUXE DRAPE PACKAGE ~/2 INCH REBOND CARPET PAD STEEL E PANEL DOQR W/STORM LIGHTED EXHAUST FANS FROST FREE FAUCET COt~NER TUBISHOWER STALL GLASS CABINETS OVER S.CQUNTER FIBEt~GLABS TUB IN HALL BATH 7~5~834-~z-19 X285 SDU't'H pR.HtR.tE VIEW it.CAD, ~Htp+P~WA FAL45. Wt 54't2q www.townandu~uatryhousing.GOm TQWni f~ GQUN'i~Y HQUSiNG.